End-stage renal disease (ESRD) occurs when your kidneys are functioning at less than 15% of normal. At this stage, your kidneys are no longer able to work well enough to keep you alive, and you will need dialysis or a kidney transplant.

The most common cause of end-stage renal disease is chronic kidney disease due to high blood pressure or diabetes.

Diabetes

Diabetes has become the most common cause of end-stage renal disease in the developed world, requiring dialysis or transplantation. This results from a steady increase in the aging population as well as better treatment of diabetes: people live longer and often long enough to develop complications such as kidney failure.

High blood pressure

The role of high blood pressure as a cause of end-stage renal disease is subject to debate. It is often difficult to determine whether high blood pressure has caused kidney failure or vice versa.

With end-stage renal disease, symptoms become more severe and can include:

confusion

difficulty breathing

difficulty sleeping

drowsiness

headaches

itchiness

nausea and vomiting

numbness of the hands or feet

skin changes

swelling of the feet and hands

weight loss

Treatment of end-stage renal disease involves dialysis (hemodialysis or peritoneal dialysis) or a kidney transplant. You may also be put on a low-protein diet and be asked to restrict your fluid, sodium, phosphate, and potassium intake. You may also be prescribed erythropoietin injections to help with anemia.